低資源環境における腹腔鏡下膵切除術の実現可能性と転帰：初期の施設経験

Background Minimally invasive approaches have transformed many areas of abdominal surgery, but their application to pancreatic resections remains limited due to technical challenges and concerns regarding safety. Objective This study's objective is to evaluate the feasibility, safety, and short-term outcomes of laparoscopic pancreatic resections during the initial institutional experience. Methods This retrospective observational study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center from April 2022 to June 2025. It included 33 patients who underwent laparoscopic pancreatic resections. Data were collected on demographics, operative variables, postoperative outcomes, and histopathology. Outcomes assessed included operative time, blood loss, conversion to open surgery, complications, hospital stay, and margin status. Results The mean age of patients was 50.2 ± 14.8 years, with 30.3% (n = 10) being male. Distal pancreatectomy was the most common procedure, performed in 66.7% (n = 22) of patients, followed by enucleation in 21.2% (n = 7) and central pancreatectomy in 12.1% (n = 4). The mean operative time was 285 ± 45 minutes, with a mean blood loss of 210 ± 75 mL. Conversion to open surgery was required in 15.2% (n = 5) of cases. Overall, 33.3% (n = 11) of patients developed postoperative complications, with pancreatic fistula occurring in 12.1% (n = 4). The majority of complications were Clavien-Dindo grades I-II in 24.2% (n = 8) of patients. The mean hospital stay was 6.4 ± 2.1 days. Thirty-day mortality occurred in 3.0% (n = 1) of patients. Histopathology revealed pancreatic ductal adenocarcinoma in 30.3% (n = 10), neuroendocrine tumors in 24.2% (n = 8), and mucinous cystadenoma in 15.2% (n = 5). An R0 resection margin was achieved in 90.9% (n = 30) of malignant cases. Conclusion Laparoscopic pancreatic resections are feasible and safe in selected patients within a resource-limited setting. Operative outcomes, complication rates, and oncological adequacy in this early experience were comparable to international series.